1
|
Peng Y, Wu H, Zhang M, Huang P. Family members' experiences of bereavement in the emergency department: A meta-synthesis of qualitative studies. Death Stud 2024:1-12. [PMID: 38459868 DOI: 10.1080/07481187.2024.2324907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
The emergency department (ED) is one of the places where patient deaths frequently occur. Understanding family members' experiences of bereavement would help provide individualized bereavement care. We conducted a meta-synthesis to synthesize family members' experiences of bereavement in the ED and assess the impact of bereavement on their lives. We searched seven international electronic databases. Five studies were selected and critically appraised. Thematic analysis was employed. Five themes (with 13 subthemes) were derived: suffering sudden changes and are severely impacted, multiple feelings and needs of waiting, final farewell, personal and family difficulties after leaving the ED, and journey through grief. Family members endured agonizing waits to see and learn more about their family members' condition. Family members reported the need for effective follow-up resources. Findings revealed that it would be helpful if the EDs could provide sensitive and respectful care to family members.
Collapse
Affiliation(s)
- Yingxin Peng
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Haoming Wu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Min Zhang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ping Huang
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
2
|
Aaronson EL, Wright RJ, Ritchie CS, Grudzen CR, Ankuda CK, Bowman JK, Kuntz JG, Ouchi K, George N, Jubanyik K, Bright LE, Bickel K, Isaacs E, Petrillo LA, Carpenter C, Goett R, LaPointe L, Owens D, Manfredi R, Quest T. Mapping the future for research in emergency medicine palliative care: A research roadmap. Acad Emerg Med 2022; 29:963-973. [PMID: 35368129 DOI: 10.1111/acem.14496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The intersection of emergency medicine (EM) and palliative care (PC) has been recognized as an essential area of focus, with evidence suggesting that increased integration improves outcomes. This has resulted in increased research in EM PC. No current framework exists to help guide investigation and innovation. OBJECTIVE The objective was to convene a working group to develop a roadmap that would help provide focus and prioritization for future research. METHODS Participants were identified based on clinical, operation, policy, and research expertise in both EM and PC and spanned physician, nursing, social work, and patient perspectives. The research roadmap setting process consisted of three distinct phases that were time staggered over 12 months and facilitated through three live video convenings, asynchronous input via an online document, and a series of smaller video convenings of work groups focused on specific topics. RESULTS Gaps in the literature were identified and informed the four key areas for future research. Consensus was reached on these domains and the associated research questions in each domain to help guide future study. The key domains included work focused on the value imperative for PC in the emergency setting, models of care delivery, disparities, and measurement of impact and efficacy. Additionally, the group identified key methodological considerations for doing work at the intersection of EM and PC. CONCLUSIONS There are several key domains and associated questions that can help guide future research in ED PC. Focus on these areas, and answering these questions, offers the potential to improve the emergency care of patients with PC needs.
Collapse
Affiliation(s)
- Emily L. Aaronson
- Department of Emergency Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | | | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Mongan Institute Center for Aging and Serious Illness Boston Massachusetts USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine NYU Grossman School of Medicine, NYU Langone Health/Bellevue Hospital Center New York New York USA
| | - Claire K. Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Jason K. Bowman
- Department of Emergency Medicine Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Joanne G. Kuntz
- Department of Palliative and Supportive Care Emory University Hospital Midtown, Emory University School of Medicine Atlanta Georgia USA
| | - Kei Ouchi
- Department of Emergency Medicine Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Naomi George
- Department of Emergency Medicine and Division of Adult Critical Care University of New Mexico School of Medicine Albuquerque New Mexico USA
| | - Karen Jubanyik
- Emergency Department Yale University School of Medicine New Haven Connecticut USA
| | - Leah E. Bright
- Department of Emergency Medicine Johns Hopkins Hospital Baltimore Maryland USA
| | - Kathleen Bickel
- Hospice and Palliative Medicine in the Division of General Internal Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Eric Isaacs
- Emergency Department Zuckerberg San Francisco General Hospital, University of California at San Francisco San Francisco California USA
| | - Laura A. Petrillo
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Christopher Carpenter
- Washington University School of Medicine in St. Louis St. Louis Missouri USA
- Department of Emergency Medicine Rutgers New Jersey Medical School Newark New Jersey USA
| | - Rebecca Goett
- Department of Emergency Medicine Rutgers New Jersey Medical School Newark New Jersey USA
| | - Lauren LaPointe
- Department of Social Work Massachusetts General Hospital Boston Massachusetts USA
| | - Darrell Owens
- University of Washington Medical Center, UW School of Medicine Seattle Washington USA
| | - Rita Manfredi
- Department of Emergency Medicine The George Washington University School of Medicine Washington DC USA
| | - Tammie Quest
- Department of Palliative and Supportive Care Emory University Hospital Midtown, Emory University School of Medicine Atlanta Georgia USA
- Department of Family and Preventive Medicine, Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
| |
Collapse
|
3
|
Ito Y, Tsubaki M, Kobayashi M. Families' experiences of grief and bereavement in the emergency department: A scoping review. Jpn J Nurs Sci 2021; 19:e12451. [PMID: 34490984 DOI: 10.1111/jjns.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
AIM Death is a frequent event in the emergency department, and many family members experience grief and bereavement. However, little is known about what families experience. The aim of this study was to explore previous findings about families' experiences of grief and bereavement in the emergency department to clarify and understand their experience. METHODS A scoping review was chosen as the design for this research. Studies were searched from four electronic databases. The obtained studies were screened independently by two reviewers and selected by mutual agreement of the entire team based upon the eligibility criteria. All relevant data were extracted, and thematic analysis was conducted to assess families' grief and bereavement experiences in the emergency department. RESULTS The database searches initially resulted in 982 studies; these were finally narrowed to 20 studies for data extraction. Publication years ranged from 1987 to 2020. The studies were conducted across nine countries; most were from the United States and had a qualitative research design. Analysis elicited the following themes: "lack of information," "breaking bad news," "being present during resuscitation," "chaotic environment," "psychosocial reaction in bereavement," and "support and care needs from healthcare professionals." CONCLUSION These themes reveal challenges in providing support and care from emergency nurses to bereaved families, including inadequate provision of information, poor design of the emergency department due to the lack of privacy, and families' unmet support and care needs. Emergency nurses need to better understand families' experience of grief and bereavement.
Collapse
Affiliation(s)
- Yoshiyasu Ito
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | | | | |
Collapse
|
4
|
Grimes CE, Stringer B, Roberts-Jones L. Simple and powerful: a consultant and governance-led bereavement service. BMJ Support Palliat Care 2020; 10:224-227. [DOI: 10.1136/bmjspcare-2018-001661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 11/03/2022]
Abstract
BackgroundFollowing bereavement, families can be left with unanswered questions or issues of concern. We piloted a bereavement service model which was consultant and governance-led with the aim to reduce complaints, reduce litigation, reduce coroners' inquests and support families.MethodsFollowing the death of a patient, the next of kin was sent an invitation. Those that responded were offered a 1-hour appointment with a consultant, senior sister and a member of the governance team. Notes were taken to track themes and feedback sheets were introduced to gauge the usefulness of the service to families.ResultsOf 121 invitations sent out, 18 families (14.8%) used the service. Two families had already sought legal advice. Neither acted further. 44% said they would have made a complaint if the service had not been available. 78% stated that they had obtained closure.ConclusionA bereavement service model which is consultant and governance led may reduce complaints and reduce litigation.
Collapse
|
5
|
Ito Y, Obana M, Kawakami D, Murakami N, Sakaguchi Y. The current status of bereavement follow-up in Japanese emergency departments: A cross-sectional nationwide survey. Int Emerg Nurs 2020; 52:100872. [PMID: 32312686 DOI: 10.1016/j.ienj.2020.100872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/24/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the current status of bereavement follow-up in Japanese emergency departments. METHODS This study employed a cross-sectional design and conducted a nationwide survey of all emergency departments in Japan. Self-reported questionnaires were sent to the nurse leaders of each emergency department. RESULTS Of 289 nurse leaders approached, 145 (50.2%) responded. Only 17.9% emergency departments provided bereavement follow-up strategies, and the most frequent strategy was referral to a specialist for psychological treatment. Most nurse leaders perceived that bereavement follow-up is necessary, and the greatest need of the bereaved as perceived by the nurse leaders was explanation of the patient's death. However, 60% of the nurse leaders perceived bereavement follow-up to be necessary but difficult, and the major challenges in bereavement follow-up were lack of time, knowledge, and skill. CONCLUSION In contemporary Japan, the prevalence of bereavement follow-up strategies offered by emergency departments was low, and although most nurse leaders perceived follow-up as necessary, it could not be provided because of limitations in human resources and staff training.
Collapse
Affiliation(s)
- Yoshiyasu Ito
- College of Nursing Art and Science, University of Hyogo, 13-71 Kitaoujicho, Akashi City, Hyogo 673-0021, Japan.
| | - Miyuki Obana
- Department of Nursing, Yokohama Municipal Citizen's Hospital, 56 Okazawacho, Hodogaya-ku, Yokohama City, Kanagawa 240 8555, Japan
| | - Daisuke Kawakami
- Department of Nursing, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa 252 0375, Japan
| | - Noriko Murakami
- Department of Psychosomatic Internal Medicine, Japanese Red Cross Kobe Hospital, 1-3-1 Wakinohamakaigandori, Chuou-ku, Kobe City, Hyogo 651 0073, Japan
| | - Yukihiro Sakaguchi
- Graduate School of Human Welfare, Kwansei Gakuin University, 1-155 Uegaharaichibancho, Nishinomiya, Hyogo City 662 8501, Japan
| |
Collapse
|
6
|
Cooper JJ, Stock RC, Wilson SJ. Emergency Department Grief Support: A Multidisciplinary Intervention to Provide Bereavement Support After Death in the Emergency Department. J Emerg Med 2020; 58:141-147. [PMID: 31744710 DOI: 10.1016/j.jemermed.2019.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The nature of death in the emergency department (ED) may put survivors at higher risk for complicated bereavement. Access to bereavement care could mitigate this, but many EDs do not include bereavement follow-up as part of their routine practice. OBJECTIVE We describe the implementation at our institution of ED Grief Support, a program developed to extend care to the bereaved through in-person, telephone, and e-mail follow-up for 1 year after the death of a loved one. METHODS Bereavement follow-up was preferentially extended to survivors of patients <45 years of age who were chosen because of the higher likelihood of unexpected death in this age group. Detailed records of each case were collected prospectively using online data management software and outcomes were recorded. Successful strategies to navigate communication and resource referrals are discussed. RESULTS We enrolled 192 patients during our 2-year period of observation. The majority died from trauma and parents were the most common next-of-kin to be contacted. Commonly requested services included: clarification of the circumstances of death, the interpretation of autopsy reports, referral to community bereavement resources, and family meetings. Challenges included supporting the emotional well-being of staff and the resource-intensive nature of the follow-up. Staff members who worked with ED Grief Support find it meaningful and note a positive influence on their well-being as providers. CONCLUSIONS Longitudinal bereavement follow-up from the ED is feasible and had a perceived positive impact on the bereaved as well as ED staff.
Collapse
Affiliation(s)
- Julie J Cooper
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware
| | - Rachel C Stock
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware
| | - Sister Julian Wilson
- Department of Pastoral Services, Christiana Care Health System, Newark, Delaware
| |
Collapse
|
7
|
Berbís‐Morelló C, Mora‐López G, Berenguer‐Poblet M, Raigal‐Aran L, Montesó‐Curto P, Ferré‐Grau C. Exploring family members’ experiences during a death process in the emergency department: A grounded theory study. J Clin Nurs 2019; 28:2790-2800. [DOI: 10.1111/jocn.14514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/17/2018] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Carme Berbís‐Morelló
- Joan XXIII University Hospital of Tarragona Tarragona Catalunya Spain
- Department of Nursing Rovira i Virgili University Tarragona Catalunya Spain
| | | | | | - Laia Raigal‐Aran
- Department of Nursing Rovira i Virgili University Tarragona Catalunya Spain
| | | | - Carme Ferré‐Grau
- Department of Nursing Rovira i Virgili University Tarragona Catalunya Spain
| |
Collapse
|
8
|
Abstract
BACKGROUND The death notification process can affect family grief and bereavement. It can also affect the well-being of involved physicians. There is no standardized process for making death notification phone calls. We assumed that residents are likely to be unprepared before and troubled after. OBJECTIVE We investigated current death notification practices to develop an evidence-based template for standardizing this process. DESIGN We used results of a literature review and open-ended interviews with faculty, residents, and widows to develop a survey regarding resident training and experience in death notification by phone. SETTING/SUBJECTS We invited all internal medicine (IM) residents at our institution to complete the survey. MEASUREMENTS Sixty-seven of 93 IM residents (72%) responded to the survey. Eighty-seven percent of responders reported involvement in a death that required notification by phone. RESULTS Eighty percent of residents felt inadequately trained for this task. Over 25% reported that calls went poorly. Attendings were involved in 17% of cases. Primary care physicians were not involved. Nurses and chaplains were not involved. Respondents never delayed notification of death until family arrived at the hospital. There was no consistent approach to rehearsing or making the call, advising families about safe travel to the hospital, greeting families upon arrival, or following up with expressions of condolence. CONCLUSIONS Poor communication skills during death notification may contribute to complicated grief for surviving relatives and stress among physicians. This study is the first to describe current practices of death notification by IM residents. More training is needed and could be combined with training in disclosure of medical error.
Collapse
Affiliation(s)
- Rachel Ombres
- 1 Hospice and Palliative Medicine Fellow, National Institutes of Health , Bethesda, Maryland
| | - Lauren Montemorano
- 2 School of Medicine Class of 2017, c/o Center for Biomedical Ethics and Humanities, University of Virginia School of Medicine , Charlottesville, Virginia
| | - Daniel Becker
- 3 Sections of General Medicine and Palliative Care, Department of Medicine, Center for Biomedical Ethics and Humanities, University of Virginia School of Medicine , Charlottesville, Virginia
| |
Collapse
|
9
|
Affiliation(s)
- Caroline Lebus
- Department of Acute Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Richard A. Parker
- Centre for Applied Medical Statistics, University of Cambridge, Cambridge, United Kingdom
- Department of Public Health and Primary Care, Institute of Public Health Cambridge, Cambridge, United Kingdom
| | | | - Derek Fraser
- Chaplaincy/Bereavement Care Lead, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jonathan Fuld
- Department of Acute Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| |
Collapse
|
10
|
Roe E. Practical Strategies for Death Notification in the Emergency Department. J Emerg Nurs 2012; 38:130-4; quiz 200. [DOI: 10.1016/j.jen.2010.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/21/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
|
11
|
Abstract
AIM This study aimed to explore the experiences of healthcare staff of caring for bereaved older people, and older people's experiences of bereavement care. BACKGROUND Loss through death of close family members, partners and friends inhibits the physical, emotional and social well being of older people. The rising population of older people and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. DESIGN A qualitative design drawing on phenomenological methodology was used to understand interactions between healthcare staff and bereaved older people. The study was set in hospital wards, general practice and community nursing teams, and care homes. Healthcare staff and a sample of recently bereaved older people participated. METHODS Purposive sampling took place to recruit staff with a range of roles, and older people who were 65 years of age or more, and bereaved of a family member or friend for between 6 months and 5 years. Participants took part in in-depth interviews, and data were analysed systematically. RESULTS Thirty-nine participants were recruited, and three key themes arose from the data: (i) Bereavement care depends on an established relationship between healthcare staff and the patient's relatives; (ii) Preparation for the relative's death may not equate to being prepared for bereavement; (iii) The 'Open Door' to bereavement care is only slightly ajar. CONCLUSIONS The study identified the interactions of healthcare staff with bereaved older people in terms of the bereavement journey. Staff demonstrated awareness of difficulties the bereaved person may encounter and showed commitment to providing support. However, lack of flexibility in services restricts meaningful interactions. IMPLICATIONS FOR PRACTICE (i) Healthcare staff may identify gaps in services in terms of preparing relatives and follow-up post-bereavement; (ii) Therapeutic relationships between staff and relatives enable ongoing support; (iii) Development of practice guidelines is a key consideration.
Collapse
Affiliation(s)
- Audrey I Stephen
- Research Fellow, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UKHonorary Reader, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UKLecturer, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK
| | | | | |
Collapse
|
12
|
Abstract
Emergency department (ED) staff confront death more frequently than any other specialty except oncology. These deaths are often traumatic, sudden, unexpected and occur in a younger age group. As a consequence, bereaved survivors have a greater risk of an abnormal grief reaction. [ Walters DT, Tupin JP (1991) Family grief in the emergency department. Emergency Medicine Clinics of North America 9(1): 189–206.] Whilst the severity or timing of traumatic injuries may preclude medical attempts to influence patient survival, the approach of the same resuscitation team to the bereaved before death, during resuscitation and after death may have profound influences on subsequent grief in the bereaved. Despite this, it can be argued that Emergency Medicine within the UK has given little thought and time for reflection upon how we treat the bereaved. That the care of the dying and the bereaved within the ED matters is greatly reinforced by the Scottish Government’s 2010 Consultation document on bereavement that states: ‘There is … evidence that the way [the] bereaved experience events around the time of death will influence their grief. Where health services get it right … bereaved people are supported to accept the death … Conversely if the health services get it wrong, then bereaved people may experience additional distress, and that distress will interfere with their successful transition through the grieving process’.
Collapse
|
13
|
Affiliation(s)
- Megan Reid
- Intensive Care Unit, Royal Alexandra Hospital, Paisley
| | - Joan McDowell
- Nursing and Healthcare, Faculty of Medicine, University of Glasgow
| | - Robert Hoskins
- Nursing and Healthcare, Faculty of Medicine, University of Glasgow
| |
Collapse
|